Page 48 - Haematologica May 2022

H.T. Greinix et al.
57.9% also were given methotrexate (MTX) while 25.3% received mycophenolate mofetil (MMF). Donor, recipient and transplant characteristics are summarized in Table 1. The median follow-up for all patients was 214 (207.4- 220.3) months, 169.3 (166.5.7-172.1) months, 127.7 (125.9-129.4) months, 81 (80.3-81.8) months and 29.7 (29.2-30.2) months for 1990-1995, 1996-2000, 2001-2005, 2006-2010, and 2011-2015, respectively.
Characteristics of aGvHD
Incidences (95% CI) of aGvHD grades II-IV by 100 days significantly (p<0.001) decreased from 40% (38- 42%), to 38% (37-39%), 32% (31-33%), 29% (28- 29%), and 28% (27-28%) for the periods 1990-1995, 1996-2000, 2001-2005, 2006-2010, and 2011-2015, respectively (Figure 1A). Of the patients who devel- oped aGvHD grades II-IV, the median days to aGvHD
(interquartile range, IQR) was 20 (14-31), 22 (15-35), 25 (16-39), 25 (16-40), and 25 (16-40) in the periods 1990- 1995, 1996-2000, 2001-2005, 2006-2010, and 2011- 2015, respectively. Involvement of the gastrointestinal (GI) tract was observed in 50.3%, 54.3%, 55.1%, 59% and 66.3% of all patients experiencing aGvHD, respec- tively. First-line therapy consisted of corticosteroids in 55.5%, 87.1%, 78.7%, 79.1%, and 72.3% of patients, respectively.
In multivariate analysis (Table 2) URD (HR 1.61 (1.54- 1.67); P<0.001), not in CR at HSCT (HR 1.25 (1.2-1.3); P<0.001) or untreated (HR 1.11 (1.02-1.2); P=0.02), BM stem cell source (HR 1.2 (1.15-1.25); P<0.001), and a female donor for a male recipient (HR 1.16; 1.11-1.21; P<0.001) were all associated with increased risk for aGvHD grades II-IV whereas the use of ATG or alem- tuzumab (HR 0.79 (0.74-0.84); P<0.001) was associated
Table 1. Transplant characteristics.
1990-1995 1996-2000 2001-2005 2006-2010 2011-2015 N(%) N(%) N(%) N(%) N(%)
P
<0.001 0.01
<0.001
<0.001
<0.001 <0.001
<0.001 <0.001
<0.001 <0.001
<0.001
Number of patients Age, median (range) Patient sex
Diagnosis
Disease status at HSCT
Donor/recipient relationship Donor/recipient sex match
Time from diagnosis to HSCT, median (range)
Conditioning intensity Stem cell source GvHD prophylaxis
ATG/Campath
Male Female MM MPE MDS AML ALL Other CR noCR Untreated Related Unrelated MM MF FM
FF
standard reduced
BM
PB
CsA alone
CsA + MTX CsA + MMF Tacrolimus + MTX Tacrolimus + MMF Other
no
yes
3512 (100) 35.4 (18-75.8) 2074 (59.1) 1438 (40.9) 154 (4.4 %) 1006 (28.6) 280 (8) 1109 (31.6) 422 (12) 541 (15.4) 2399 (69.6) 940 (27.3) 107 (3.1) 2954 (84.1) 558 (15.9) 1195 (34.3) 862 (24.7) 765 (21.9) 664 (19) 8.6 (0-237.2)
3335 (100)
3369 (95.9) 143 (4.1) 276 (9) 2340 (76.3)
451 (14.7)
2821 (89.5)
331 (10.5)
9521 (100) 39.4 (18-71.7) 5598 (58.8) 3923 (41.2) 460 (4.8) 3140 (33) 797 (8.4) 2437 (25.6) 1106 (11.6) 1581 (16.6) 5928 (64) 3004 (32.4) 333 (3.6 %) 6776 (71.2) 2745 (28.8) 3389 (36.2) 2117 (22.6) 2040 (21.8) 1803 (19.3) 9.8 (0-238.2)
6187 (83)
1263 (17) 5411 (56.8) 4110 (43.2) 811 (12.4) 4244 (64.6) 167 (2.5)
1(0.0)
1342 (20.4)
5150 (74.1)
1798 (25.9)
19865 (100) 44.5 (18-77.3) 11555 (58.2) 8310 (41.8) 1912 (9.6) 3071 (15.5) 1935 (9.7) 5754 (29) 2320 (11.7) 4873 (24.5) 11022 (57.3) 7178 (37.3) 1042 (5.4) 12406 (62.5) 7459 (37.5) 7184 (36.8) 4178 (21.4) 4511 (23.1) 3657 (18.7) 10.6 (0.1-239.8)
11324 (58.6)
8009 (41.4)
4685 (23.6 %)
15180 (76.4)
1808 (15.6)
5703 (49.1)
1805 (15.5)
26 (0.2)
59 (0.5)
2207 (19)
7680 (59.8)
5169 (40.2)
30194 (100) 48.9 (18-83.8) 17633 (58.4) 12561 (41.6) 2111 (7) 2768 (9.2) 3800 (12.6) 10358 (34.3) 3726 (12.3) 7431 (24.6) 17573 (60) 10071 (34.4) 1668 (5.7) 14486 (48) 15708 (52) 11413 (38.5) 5887 (19.9) 7020 (23.7) 5303 (17.9) 10.2 (0-238.3)
15610 (52.1)
14324 (47.9)
4094 (13.6)
26100 (86.4)
3627 (13.5)
11574 (43.1)
6009 (22.4)
301 (1.1)
782 (2.9)
4581 (17)
13531 (48.8)
14194 (51.2)
39465 (100) 52.4 (18-79.7) 23481 (59.5) 15984 (40.5) 2382 (6) 3306 (8.4) 6258 (15.9) 13799 (35) 4550 (11.5) 9170 (23.2) 24068 (62.7) 12274 (32) 2016 (5.3) 15262 (38.7) 24203 (61.3) 15851 (41) 7176 (18.6) 9227 (23.9) 6424 (16.6) 9 (0-239.9)
18806 (48.3)
20123 (51.7)
3816 (9.7)
35649 (90.3)
4682 (12.1)
14962 (38.6)
9053 (23.4)
659 (1.7)
1327 (3.4)
8062 (20.8)
15420 (39.2)
23956 (60.8)
AML: acute myeloid leukemia; ALL: acute lymphoblastic leukemia; MDS: myelodysplastic syndrome; MPE: myeloproliferative disease; MM: myeloma; HSCT: hematopoietic stem cell transplantation; CR: complete remission; URD: unrelated donor; BM: bone marrow; PBSC: peripheral blood stem cells; CsA: cyclosporine A; MTX: methotrexate; MMF: mycophenolate mofetil; ATG: antithymocyte globulin.
1056
haematologica | 2022; 107(5)